Defibrillator-equipped drones could be 1st on scene in cardiac arrest

A drone could get to a patient faster than emergency services and could increase survival rates

Dispatching drones outfitted with defibrillators like the one above, in yellow, could cut response times and increase survival rates during cardiac arrest. Currently, only 10 per cent of people survive a cardiac arrest that occurs outside a hospital. (Ashley Burke/CBC)

Blair Bigham

Blair Bigham is a resident emergency physician and freelance journalist who reports on the undertold stories of patients, caregivers and the systems that help or fail them.

When a heart stops beating, a defibrillator shock needs to be applied within minutes.

But for many Canadians, fire trucks and ambulances can't get to the scene fast enough. On average, only 10 per cent of people who suffer cardiac arrest outside of hospital survive (cardiac arrest is distinct from a heart attack, which can sometimes, but not always, cause cardiac arrest).

Marsha Hawthorne waited 32 minutes for an ambulance to arrive after her husband, Curtis, went into cardiac arrest one night six years ago after putting their two kids to bed.

"When I was on the phone with 911, all I could think was, 'Every second, I'm losing him.' Every split second I was losing him if I didn't get them here," Hawthorne said.

"It was devastating because I was trying to save his life because I promised I'd save his life. And also to save my kids lives because it would destroy them."

Marsha Hawthorne's husband, Curtis, went into cardiac arrest one night in February 2010 and died while waiting for the ambulance to arrive. It took more than half hour to come to the couple's home in a rural area outside of Ottawa. (Ashley Burke/CBC)

Hawthorne performed CPR on her husband, but by the time the ambulance arrived at their home in Beachburg, a rural area outside of Ottawa, from Eganville, about 40 km away, it was too late.

"It is the hardest thing that anybody can go through being a widow at 32," Hawthorne said. "You're supposed to raise your family together with the one person you married. I didn't get to do that. So, we lost an amazing man, an amazing father."

Response times could be cut by more than half

The Heart and Stroke Foundation of Canada estimates that about 40,000 Canadians suffer cardiac arrest each year.

University of Toronto computer science engineer Timothy Chan thinks that drone technology might help a greater proportion of them survive.

Using computer models, he has determined that strategically placed drones carrying defibrillators could beat ambulances to the scene by many minutes and, in some cases, cut response times in half, increasing the chances of survival.

When the heart stops beating, the chance of survival drops seven to 10 per cent for every minute a defibrillator doesn't deliver a lifesaving electrical shock to restart the heart, according to the Heart and Stroke Foundation.

But ambulance response times average five to 10 minutes in cities and often more than 20 minutes in rural communities, meaning firefighters and paramedics, who carry defibrillators, often arrive too late.

Brian Leahey, deputy chief of the County of Renfrew Paramedic Service, shows off a drone carrying a defibrillator during a demonstration in Carp, Ont., west of Ottawa this week. (Ashley Burke/CBC)

A discussion with an emergency doctor about cardiac arrest prompted Chan to investigate whether a drone could reduce response times.

His research team at the University of Toronto studied historical ambulance response times to 56,000 cardiac arrests that occurred in southern Ontario over a nine-year period. They then applied a mathematical algorithm to determine where drones would have to be placed to arrive faster than 911 responders.

Chan looked at the impact of a network of 81 drone bases with 100 drones in the eight municipalities in the Greater Toronto Area. He determined that would cut the time it takes for ambulances to arrive by more than half in 90 per cent of cardiac arrests.

Tim Chan, Angela Schoellig and Justin Boutillier are the three principal investigators at University of Toronto working on using drones to quickly and safely deliver defibrillators to people who have suffered a cardiac arrest. (Liz Do)

Rural regions would see average response times drop from 19 minutes to nine minutes in 90 per cent of cases, and urban centres would see response times drop from just more than 10 minutes to less than four.

"I think that is an amazing idea," Hawthorne said. "I think that drone idea will save a lot of people's lives. I applaud them for finding ways to help people. I never want anybody to go through [what I did]."

Faster than ambulances

If drones could deliver defibrillators faster than ambulances, "thousands of lives could be saved," said Michael Nolan, director of the paramedic service for Renfrew County, near Ottawa.

Mike Nolan, is chief of the Renfrew County Paramedic Service and is in charge of its drone pilot project. (Ashley Burke/CBC)

"We've proven these concepts. Now, we need to integrate them within the regulatory framework," he said.

He envisions a 911 system where pilots sit beside dispatchers and fly the drones remotely. Once a drone arrives on someone's doorstep, the 911 dispatcher would guide the caller through the steps to deliver a shock.

Already accustomed to coaching people through emergency childbirth and CPR, dispatchers could walk people easily through using the defibrillator and then stay on the line until paramedics arrive.

The technology needed to fly defibrillators to 911 callers exists today, says Angela Schoellig, an assistant professor at the Institute for Aerospace Studies at the University of Toronto and an expert on drones. Drones could fly 100 km/h directly to an emergency, even in inclement Canadian weather, she says.

The drone the County of Renfrew plans to use in its pilot project costs about $10,000. (Ashley Burke/CBC)

While drones can be piloted remotely, they can also fly themselves. Self-flying drones are guided by dependable GPS systems and could respond quickly to nearby aircraft, Schoellig said.

Test coming in Renfrew County

Currently, drone operators must follow Transport Canada regulations governing model aircraft and unmanned aerial vehicles, which include always keeping the drone within the operator's line of sight. Those flying drones heavier than 35 kg for personal use or 25 kg for work and research must get a special operations certificate.

Transport Canada grants some exemptions to its regulations for specific work, research and test flights.

Renfrew County paramedics have been using drones to survey accident scenes since 2014, but they haven't yet flown them beyond the operator's line of sight. That could soon change now that they are working with Transport Canada on a regulatory framework for defibrillator-carrying drones. Renfrew has partnered with Victoria-based drone maker Indro Robotics to seek a special exemption.

Indro has received exemptions before and is recognized as a safe operator by Transport Canada.

Transport Canada spokesperson Natasha Gauthier says the idea that drones could help saves lives is "exciting" but warns "they are aircraft and should be treated as aircraft."

The agency says it supports innovation in drone technology. On Nov. 3, Transport Minister Marc Garneau granted the village of Foremost, Alta., approval to begin flying drones beyond the operator's line of sight at a special research facility with restricted airspace.

Transport Minister Marc Garneau granted the village of Foremost, Alta., approval to test drones at a special research facility with restricted airspace. (Sean Kilpatrick/Canadian Press)

"This will facilitate research and development and provide the industry with dedicated, restricted airspace where they can test BVLOS (beyond visual line of sight) technology and operations," said Aaron McCrorie, director-general of civil aviation for Transport Canada, in a statement.

Still, Transport Canada said it approaches each exemption request on a case-by-case basis, paying close attention to the nature of the cargo, which could fall out of the drone, and other risks.

"Any payload that could be dropped from a UAV could be dangerous, and the department would take this into account," McCrorie said. "To receive permission to carry out such activities, an operator would need to demonstrate to us their ability to mitigate the heightened risk to people on the ground and to other aircraft."

Closing the rural-urban gap

Innovations such as defibrillator-carrying drones could be used to "close the survival gap" between rural and urban centres, said Heart and Stroke Foundation communications director Rhae Ann Bromley. In cities, survival rates from cardiac arrest can be as high as 12 per cent, but in rural areas, they can be as low as five per cent.

Bromley emphasized that a bystander's first reaction when coming upon someone who has collapsed and isn't breathing normally should still be to call 911, start chest compressions and look for a defibrillator nearby.

While tens of millions of dollars have been spent distributing thousands of defibrillators in hockey rinks, airports and other public spaces across Canada, only 20 per cent of cardiac arrests occur in public. For everyone else, defibrillator-carrying drones might one day soon be the difference between life and death.